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WB Says Indonesia on Course For Universal Health Coverage
Nurfika Osman | May 28, 2009

A child gets a medical checkup in Bali as part of bird flu prevention efforts. (Photo: Made Nagi, EPA) A child gets a medical checkup in Bali as part of bird flu prevention efforts. (Photo: Made Nagi, EPA)
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TheMan
4:51pm May 28, 2009

Universal health insurance should be a national priority. But what about the country's rural populations who barely have regular access to a Puskesmas clinic, let alone the money to pay for treatments? These underserved groups must not be forgotten as the government pursues health care reform.

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The World Bank is encouraging the government to stay the course in providing health care coverage for all its citizens.

“Indonesia could potentially become one of the very few middle-income countries to successfully provide universal health insurance coverage for its population,” Joachim von Amsberg, the World Bank’s country director for Indonesia, said on Wednesday.

“Already we are seeing the government make positive headway on this agenda through the Askeskin and Jamkesmas programs for the poor and near poor.

“However, the country still faces significant challenges in developing and implementing an effective and sustainable health financing reform.”

Von Amsberg said the key to success was obtaining the necessary information and assuring that the policy process addressed both the big picture of reform as well as the key design parameters.

“Whatever the choice is, it is not up to us,” he said. “We are only encouraging the government to take the best decision to get the maximum result of health outcomes, as well as protecting the citizens’ and the country’s financial health.”

Three possible approaches, based on existing health financing programs, the current policy debate and the 2004 Social Security Law, have been identified as viable universal coverage options.

The first possible approach approximates a National Health Service like that in Sri Lanka and Malaysia, and involves expanding the general revenue-financed Jamkesmas program for the poor and near poor to cover the entire population.

The second approach is the “new” national Social Health Insurance model, which is now called Mandatory Health Insurance. The MHI system is funded through both wage-based contributions from public and private sector workers and retirees, and government general revenue contributions for the poor and other disadvantaged groups.

The third possible approach could be considered a variant of the second option or a combination of the first and second options . It would provide coverage for the poor and other disadvantaged groups through a government -funded system, with others covered through multiple MHI funds, each financed on a contributory basis.

The World Bank will launch today the book “Health Financing in Indonesia: A Reform Road Map,” which examines the government’s efforts to provide health insurance coverage for the population and its concrete actions to provide health insurance coverage for the poor and near poor through the Askeskin and Jamkesmas programs.

The book assesses the government’s existing health policy based on the degree of access, quality, health outcomes, financial protection, efficiency, equity and financial sustainability.